四肢长骨淋巴瘤影像学特征：一项影像学结果的观察性研究

Radiologic Findings that Aid in the Diagnosis of Lymphoma Occurring in the Long Bones: An Observational Study

摘要: 目的：讨论发生在四肢长骨的淋巴瘤的影像特征。方法：回顾性分析22例经淋巴结活检、骨髓穿刺或手术病理证实为四肢长骨淋巴瘤患者的影像，总结其影像学特征。结果：CT检查12例，均有骨质破坏，其中83.3% (10/12)为溶骨型，8.3% (1/12)为混合型，8.3% (1/12)为硬化型，66.7% (8/12)呈偏心性；66.7% (8/12)呈现“骨小破坏、软组织大肿块”；58.3% (7/12)有骨膜反应；25% (3/12)伴病理骨折；75% (9/12)存在“浮冰征”；25% (3/12)见“骨皮质开窗征”。MRI检查20例，40% (8/20)T2WI表现出“马赛克征”；45% (9/20)肿块超出骨破坏范围；40% (8/20)见“骨皮质开窗征”；MRI增强扫描5例，80% (4/5)见“镶边征”。结论：本研究表明：发生在四肢长骨的淋巴瘤具有特定征象，当病变表现为溶骨性、偏心性骨质破坏，出现“骨小破坏、软组织大肿块”，以及“浮冰征”、“骨皮质开窗征”、“镶边征”、骨膜反应及T2WI“马赛克征”时，应高度怀疑长骨淋巴瘤的诊断。

Abstract: Purpose: To discuss the imaging features of lymphoma occurring in the long bones. Methods: Reviewing 22 cases with lymphoma of the long bones confirmed by lymph node biopsy, bone marrow aspiration, or surgical pathology. Analyzing and summarizing their radiological features. Results: Of the 12 patients who underwent CT scans, all had bone destruction; 83.3% (10/12) showed osteolytic lesions, 8.3% (1/12) presented mixed lesions, and another 8.3% (1/12) displayed sclerotic lesions; 66.7% (8/12) displayed eccentric involvement; 66.7% (8/12) manifests as a large soft tissue mass with small bone destruction; 58.3% (7/12) exhibited periosteal reaction; 25% (3/12) accompanied by pathological fracture; 75% (9/12) demonstrated “ice-floating sign;” and 25% (3/12) demonstrated “windowing sign in cortical bone.” Of the 20 patients who underwent MRI, 40% (8/20) exhibited a “mosaic sign” on T2WI. 45% (9/20) of the masses extended beyond the extent of bone destruction. 40% (8/20) exhibited the “windowing sign in cortical bone.” The contrast-enhanced MRI performed in 5 cases, 80% (4/5) demonstrated the “Lace-like sign.” Conclusion: Lymphoma occurring in the long bones has certain characteristics. When the lesion is osteolytic, eccentric, and presents with large mass with small bone destruction, along with signs such as “ice-floating sign,” “windowing sign in cortical bone,” “Lace-like sign,” layered or spiculated periosteal reaction, and the appearance of a “mosaic sign” on T2WI, a high suspicion of long bones lymphoma diagnosis should be considered.